Hopkins Nathan D M, Lawrie Steven
Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Sunshine Coast Orthopaedic Clinic, Suite 17 Level 2, Kawana Private Hospital, 5 Innovation Parkway, Birtinya, QLD, 4575, Australia.
J Exp Orthop. 2021 Sep 27;8(1):82. doi: 10.1186/s40634-021-00405-3.
The main purpose of this study was to investigate clinical and radiological outcomes of medial meniscus posterior root tear (MMPRT) repair in knees with advanced articular cartilage degeneration and osteoarthritis compared to those with minimal degenerative change.
Thirty-three knees underwent MMPRT repair using an arthroscopic pullout repair tibial tunnel technique. Clinical scores including Lysholm Score, International Knee Documentation Committee (IKDC) Score and Knee injury and Osteoarthritis Outcome (KOOS) Score were collected preoperatively and sequentially at 6 months, 12 months and mean final follow-up of 39.4 months. Kellgren-Lawrence (K-L) osteoarthritis grade, Outerbridge classification of cartilage degeneration and the presence of bone marrow oedema on MRI were also evaluated.
All clinical scores improved at final follow-up for knees with K-L grade ≥ 2 osteoarthritis (p < 0.001), with no significant difference compared to K-L 0/1. Patients with Outerbridge class 3/4 cartilage degeneration also reported improvements in clinical scores, albeit lower than those with class 2 degeneration (p < 0.05). During recovery, the majority of patients reported clinical improvements by 6 months, and six patients further improved by at least 15 points in IKDC score between 6 and 12 months. Osteoarthritis progressed in 10 of 31 knees (32%), with an overall mean pre-operative K-L grade of 1.6 ± 0.9 compared to 2.0 ± 0.9 at final follow-up (n.s.). No knees progressed to K-L 4 or underwent re-operation. Pre-operative bone marrow oedema was present in 17 knees (52%), all of which had signal localised to the medial tibia or femur. Oedema had resolved in all but 5 knees post-operatively (p < 0.01).
Arthroscopic repair of medial meniscus posterior root tears is associated with improved outcomes in knees with advanced cartilage degeneration and osteoarthritis. Meaningful improvements in clinical outcomes can be achieved beyond 6 months, thus success of the operation is best determined at the 12-month mark. Oedema signal significantly improved post-operatively, however a relatively high proportion of knees had K-L progression.
IV - Case Series.
本研究的主要目的是调查与关节软骨退变和骨关节炎程度较轻的膝关节相比，晚期关节软骨退变和骨关节炎膝关节内侧半月板后根撕裂（MMPRT）修复的临床和放射学结果。
33例膝关节采用关节镜下胫骨隧道拉出修复技术进行MMPRT修复。术前及术后6个月、12个月和平均最终随访39.4个月时依次收集临床评分，包括Lysholm评分、国际膝关节文献委员会（IKDC）评分和膝关节损伤与骨关节炎转归（KOOS）评分。还评估了Kellgren-Lawrence（K-L）骨关节炎分级、软骨退变的Outerbridge分类以及MRI上骨髓水肿的情况。
K-L分级≥2级骨关节炎的膝关节在最终随访时所有临床评分均有所改善（p<0.001），与K-L 0/1级相比无显著差异。Outerbridge 3/4级软骨退变的患者临床评分也有改善，尽管低于2级退变患者（p<0.05）。在恢复过程中，大多数患者在6个月时报告临床症状改善，6例患者在6至12个月间IKDC评分进一步提高至少15分。31例膝关节中有10例（32%）骨关节炎进展，术前总体平均K-L分级为1.6±0.9，最终随访时为2.0±0.9（无统计学意义）。没有膝关节进展到K-L 4级或接受再次手术。术前17例膝关节（52%）存在骨髓水肿，所有水肿信号均位于胫骨内侧或股骨。术后除5例膝关节外，其余水肿均已消退（p<0.01）。
关节镜下内侧半月板后根撕裂修复与晚期软骨退变和骨关节炎膝关节的预后改善相关。6个月后临床结果可实现有意义的改善，因此手术成功与否最好在12个月时确定。术后水肿信号明显改善，但相当一部分膝关节有K-L分级进展。
IV - 病例系列。
